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Non-Hodgkin’s lymphoma in systemic lupus erythematosus
  1. S Bernatsky1,
  2. R Ramsey-Goldman2,
  3. R Rajan1,3,
  4. J-F Boivin4,
  5. L Joseph1,4,
  6. S Lachance3,
  7. D Cournoyer3,
  8. A Zoma5,
  9. S Manzi6,
  10. E Ginzler7,
  11. M Urowitz8,
  12. D Gladman8,
  13. P R Fortin8,
  14. S Edworthy9,
  15. S Barr9,
  16. C Gordon10,
  17. S-C Bae11,
  18. J Sibley12,
  19. K Steinsson13,
  20. O Nived14,
  21. G Sturfelt14,
  22. Y St Pierre1,
  23. A Clarke1,15
  1. 1Division of Clinical Epidemiology Montreal General Hospital, Montreal, PQ, Canada
  2. 2Division of Rheumatology, Northwestern University, Chicago IL, USA
  3. 3Department of Oncology, Montreal General Hospital, PQ, Canada
  4. 4Department of Epidemiology and Biostatistics, McGill University, Montreal, PQ, Canada
  5. 5Lanarkshire Centre for Rheumatology, Hairmyres Hospital, Scotland, UK
  6. 6University of Pittsburgh School of Medicine and GSPH, Pittsburgh, Pennsylvania, USA
  7. 7SUNY-Downstate Medical Center, Brooklyn, NY, USA
  8. 8Toronto Western Division of University Health Network, University of Toronto, Toronto, ON, Canada
  9. 9University of Calgary, Calgary, AB, Canada
  10. 10Department of Rheumatology, University of Birmingham, Birmingham, UK
  11. 11Department of Internal Medicine, Division of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea
  12. 12Department of Rheumatology, Royal University Hospital, Saskatoon, SK, Canada
  13. 13Department of Rheumatology and Center for Rheumatology Research, Landspitalinn; University Hospital, Reykjavik, Iceland
  14. 14Department of Rheumatology, University Hospital, Lund, Sweden
  15. 15Division of Clinical Immunology/Allergy, Montreal General Hospital, PQ, Canada
  1. Correspondence to:
    Dr S Bernatsky
    1650 Cedar Avenue, Room L10-424, Montreal, Quebec H3G 1A4, Canada;


Background: Recent evidence supports an association between systemic lupus erythematosus (SLE) and non-Hodgkin’s lymphoma (NHL).

Objectives: To describe demographic factors, subtypes, and survival of patients with SLE who develop NHL.

Methods: A multi-site cohort of 9547 subjects with definite SLE was assembled. Subjects at each centre were linked to regional tumour registries to determine cancer cases occurring after SLE diagnosis. For the NHL cases ascertained, descriptive statistics were calculated, and NHL subtype frequency and median survival time of patients determined.

Results: 42 cases of NHL occurred in the patients with SLE during the 76 948 patient-years of observation. The median age of patients at NHL diagnosis was 57 years. Thirty six (86%) of the 42 patients developing NHL were women, reflecting the female predominance of the cohort. In the patients, aggressive histological subtypes appeared to predominate, with the most commonly identified NHL subtype being diffuse large B cell (11 out of 21 cases for which histological subtype was available). Twenty two of the patients had died a median of 1.2 years after lymphoma diagnosis.

Conclusions: These data suggest aggressive disease in patients with SLE who develop NHL. Continuing work should provide further insight into the patterns of presentation, prognosis, and aetiology of NHL in SLE.

  • CI, confidence interval
  • MALT, mucosa associated lymphoid tissue
  • NHL, non-Hodgkin’s lymphoma
  • SLE, systemic lupus erythematosus
  • systemic lupus erythematosus
  • malignancy
  • non-Hodgkin’s lymphoma
  • cancer

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  • Ethics approval: The study was approved by the ethics review boards of all participating institutions and was conducted in accordance with the Declaration of Helsinki ethical principles.